Really wondering why that stitch in the ED costs more than $500. This is why:

"$584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator...In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year. Likewise, Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012, the year he retired, but total compensation of $21.7 million."

It's not their fault, I would do the same thing in their shoes. The government mandated a middle man with their universal insurance. They are forcing doctors to join large groups or hospitals just to stay afloat because of the differences in reimbursement for the same procedures (facility fees) along with unnecessary enormous expenses (electronic medical records, huge malpractice coverage required because of the poor medicolegal environment). Everyone will be reaching into your pocket while telling you how to do your job. I'm here because I can't see myself doing anything else. But I have a friend who didn't make it into medical school and is studying to be a healthcare administrator which I think will work out well for him. Don't listen to anyone who tells you to follow your heart or do what you love. Listen to people who have gone through what you want to do and try to look at the trends. There are many reasons for why the surgical subspecialties are competitive while primary care is not.

They are forcing doctors to join large groups or hospitals just to stay afloat because of the differences in reimbursement for the same procedures (facility fees) along with unnecessary enormous expenses (electronic medical records, huge malpractice coverage required because of the poor medicolegal environment).

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This is what they want you to think. Find the actual numbers on this and you will realize it is not an issue. The move to consolidation is a power grab from hospital administrators who are interested in consolidating power. It is a push to remove agency from individual physicians and turn physicians into laborers.

Really wondering why that stitch in the ED costs more than $500. This is why:

"$584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator...In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year. Likewise, Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012, the year he retired, but total compensation of $21.7 million."

First, Bertolini is not a hospital administrator. He is the CEO of the 5th largest insurance carrier in the United States. His company has a net income of just under $2 billion per year and manages just shy of 50k employees. An exceptional executive is worth millions of dollars per year. Their decisions make or lose their companies hundreds of millions of dollars over the course of their tenure. To secure what is considered top talent, firms pay premium. Now, the CEO of the hospital that I work at makes $4.5 million a year. He is worth every penny of that. And this is coming from one of the most overworked and underpaid people under him.

Second, these salaries are at best 3 jumps away from affecting the costs of an ER visit. There are so many other things that can be directly attributed to increasing costs.

Lastly, the problem is the system in place, not the individuals or their salaries. And... its not going to change. The driving force behind why hospitals are designed the way they are is "customer satisfaction" and an expectation of the highest quality and standard in every aspect of what we do. This automatically drives up the costs of business. Layer on top of that that the fundamental model for how we bill and pay people, and you have a broken system that nobody has any good ideas on how to fix.

It's not their fault, I would do the same thing in their shoes. The government mandated a middle man with their universal insurance. They are forcing doctors to join large groups or hospitals just to stay afloat because of the differences in reimbursement for the same procedures (facility fees) along with unnecessary enormous expenses (electronic medical records, huge malpractice coverage required because of the poor medicolegal environment). Everyone will be reaching into your pocket while telling you how to do your job. I'm here because I can't see myself doing anything else. But I have a friend who didn't make it into medical school and is studying to be a healthcare administrator which I think will work out well for him. Don't listen to anyone who tells you to follow your heart or do what you love. Listen to people who have gone through what you want to do and try to look at the trends. There are many reasons for why the surgical subspecialties are competitive while primary care is not.

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Sorry but the AHA has actively tried to **** doctors in the Obamacare bill with certain amendments. The AHA is only on the side of doctors when it serves their interests in consolidating their power even further. At the tip of the hat, they turn on you, as they have done with anesthesiologists and taking the side of CRNAs. Hospital administrators hate paying physician salaries and if they could find any alternative they would - and they have tried.

Lastly, the problem is the system in place, not the individuals or their salaries. And... its not going to change. The driving force behind why hospitals are designed the way they are is "customer satisfaction" and an expectation of the highest quality and standard in every aspect of what we do. This automatically drives up the costs of business.

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Customer satisfaction and high standards certainly contribute to high costs. But they do not make it inevitable that costs should rise. Innovation (and some would say regulation) can reduce cost growth, as in other industries.

Customer satisfaction and high standards certainly contribute to high costs. But they do not make it inevitable that costs should rise. Innovation (and some would say regulation) can reduce cost growth, as in other industries.

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Can you share the examples of medical innovations that were shown to reduce the cost growth?

Can you share the examples of medical innovations that were shown to reduce the cost growth?

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Hard question! Here's a good discussion, by Austin Frakt in 2010, on some successes in payment reform. Crucial to this debate is that they were temporary successes, reversed by public, industry, and/or political pressure.

The high standards we have for health care makes it hard to achieve these reductions. I don't think throwing up our hands makes sense. Here's Frakt on this:

"But [previous failure] doesn’t mean we shouldn’t try or that some of those ideas can’t work if tweaked in certain ways. It just means that we should be humble, prepared to fail and keep thinking of new ideas to replace the ones that don’t work out. "